Early clinical surrogates for outcome prediction after stroke thrombectomy in daily clinical practice.
Journal
Journal of neurology, neurosurgery, and psychiatry
ISSN: 1468-330X
Titre abrégé: J Neurol Neurosurg Psychiatry
Pays: England
ID NLM: 2985191R
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
05
05
2020
revised:
30
06
2020
accepted:
01
07
2020
entrez:
16
9
2020
pubmed:
17
9
2020
medline:
23
3
2021
Statut:
ppublish
Résumé
To investigate early clinical surrogates for long-term independency of patients treated with thrombectomy for large vessel occlusion stroke in daily clinical routine. All patients with anterior circulation stroke enrolled in the German Stroke Registry-Endovascular Treatment from 07/2015 to 04/2018 were analysed. National Institute of Health Stroke Scale (NIHSS) on admission, NIHSS percentage change, NIHSS delta and NIHSS at 24 hours as well as existing binary definitions of early neurological improvement (ENI; improvement of 8 (major ENI)/10 (dramatic ENI) NIHSS points or reaching 0/1 were compared for predicting functional outcome at 90 days using the modified Rankin Scale (mRS). Excellent and favourable outcome were defined as 0-1 and 0-2, respectively. Among 2262 endovasculary treated patients with acute ischaemic anterior circulation stroke, NIHSS at 24 hours had the highest discriminative ability to predict excellent (receiver operator characteristics (ROC) The NIHSS at 24 hours postintervention with a threshold of ≤8 points serves best as a surrogate for long-term functional outcome after thrombectomy for anterior circulation stroke in daily clinical practice. Only advanced age significantly decreases its predictive value.
Sections du résumé
BACKGROUND AND PURPOSE
To investigate early clinical surrogates for long-term independency of patients treated with thrombectomy for large vessel occlusion stroke in daily clinical routine.
METHODS
All patients with anterior circulation stroke enrolled in the German Stroke Registry-Endovascular Treatment from 07/2015 to 04/2018 were analysed. National Institute of Health Stroke Scale (NIHSS) on admission, NIHSS percentage change, NIHSS delta and NIHSS at 24 hours as well as existing binary definitions of early neurological improvement (ENI; improvement of 8 (major ENI)/10 (dramatic ENI) NIHSS points or reaching 0/1 were compared for predicting functional outcome at 90 days using the modified Rankin Scale (mRS). Excellent and favourable outcome were defined as 0-1 and 0-2, respectively.
RESULTS
Among 2262 endovasculary treated patients with acute ischaemic anterior circulation stroke, NIHSS at 24 hours had the highest discriminative ability to predict excellent (receiver operator characteristics (ROC)
CONCLUSION
The NIHSS at 24 hours postintervention with a threshold of ≤8 points serves best as a surrogate for long-term functional outcome after thrombectomy for anterior circulation stroke in daily clinical practice. Only advanced age significantly decreases its predictive value.
Identifiants
pubmed: 32934109
pii: jnnp-2020-323742
doi: 10.1136/jnnp-2020-323742
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1055-1059Investigateurs
Tobias Boeckh-Behrens
(T)
Silke Wunderlich
(S)
Arno Reich
(A)
Martin Wiesmann
(M)
Ulrike Ernemann
(U)
Till-Karsten Hauser
(TK)
Eberhard Siebert
(E)
Sarah Zweynert
(S)
Georg Bohner
(G)
Alexander Ludolph
(A)
Karl-Heinz Henn
(KH)
Waltraud Pfeilschifter
(W)
Marlis Wagner
(M)
Joachim Röther
(J)
Bernd Eckert
(B)
Jörg Berrouschot
(J)
Albrecht Bormann
(A)
Christian Gerloff
(C)
Elke Hattingen
(E)
Gabor Petzold
(G)
Sven Thonke
(S)
Christopher Bangard
(C)
Christoffer Kraemer
(C)
Martin Dichgans
(M)
Frank Wollenweber
(F)
Lars Kellert
(L)
Franziska Dorn
(F)
Moriz Herzberg
(M)
Marios Psychogios
(M)
Jan Liman
(J)
Martina Petersen
(M)
Florian Stögbauer
(F)
Peter Kraft
(P)
Mirko Pham
(M)
Michael Braun
(M)
Gerhard F Hamann
(GF)
Andreas Kastrup
(A)
Christian Roth
(C)
Klaus Gröschel
(K)
Timo Uphaus
(T)
Volker Limmroth
(V)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: JF: Research support from the German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions-/Förderbank (IFB), Medtronic, Microvention, Philips, Stryker; consultancy appointments; Acandis, Bayer, Boehringer Ingelheim, Cerenovus, Covidien, Evasc Neurovascular, MD Clinicals, Medtronic, Medina, Microvention, Penumbra, Route92, Stryker, Transverse Medical; stock holdings for Tegus. GT: Consultant for Acandis, Bayer Healthcare, Boehringer Ingelheim, BristolMyersSquibb/Pfizer, Covidien, Glaxo Smith Kline; lead investigator of the WAKE-UP study; principal investigator of the THRILL study; Grants by the European Union (Grant No. 278276 und 634809) and Deutsche Forschungsgemeinschaft (SFB 936, Projekt C2).GT: reports receiving consulting fees from Acandis, grant support and lecture fees from Bayer, lecture fees from Boehringer Ingelheim, BristolMyersSquibb/Pfizer, and DaiichiSankyo, and consulting fees and lecture fees from Portola and Stryker.